Even by rural hospital standards, in southeastern Iowa is small.
The 14-bed hospital, in Sigourney, doesn鈥檛 do surgeries or deliver babies. The small 24-hour emergency room is overseen by two full-time doctors.
CEO Matt Ives wants to hire a third doctor, but he said finding physicians for a rural area has been challenging since the covid-19 pandemic. He said several physicians at his hospital have retired since the start of the pandemic, and others have decided to stop practicing certain types of care, particularly emergency care.
Another rural hospital is down the road, about a 40-minute drive east. Washington County Hospital and Clinics has 22 beds and is experiencing similar staffing struggles. 鈥淥ver the course of the last few years, we鈥檝e had not only the pandemic, but we鈥檝e had kind of an aging physician workforce that has been retiring,鈥� said Todd Patterson, CEO.
The pandemic was difficult for health workers. Many endured long hours, and the stresses on the nation鈥檚 health care system prompted more workers than usual .
鈥淭here鈥檚 a chunk of workers that were lost and won鈥檛 come back,鈥� said , who directs the at the University of California-San Francisco. 鈥淔or a lot of the clinicians that decided and were able to stick it out and work through the pandemic, they have burned out,鈥� Spetz said.
Five years after the World Health Organization declared covid a global pandemic and the first Trump administration announced a national emergency, the United States faces a crucial shortage of medical providers, for an aging population.
That could have , particularly in states like Iowa with significant rural populations. Experts say the problem has , but the effects of the pandemic accelerated the shortages by pushing many doctors over the edge .
鈥淪ome of them made it through covid like 鈥楲et鈥檚 get us through this public health crisis,鈥� and then they came out of it saying, 鈥極K, and now? Now I鈥檓 exhausted,鈥欌�� said Christina Taylor, president of the .
鈥淚owa is absolutely in the middle of a physician shortage,鈥� Taylor said. 鈥淚t鈥檚 a true crisis for us. We鈥檙e actually 44th in the country in terms of .鈥�
A 2022 survey by the Centers for Disease Control and Prevention found a who reported feeling burned out and wanting a new job, compared with 2018. The number of people in health care has , said , an associate professor at the University of Minnesota鈥檚 School of Public Health, but the growth has not happened fast enough.
鈥淲e have an aging population. We have a lot of needs,鈥� she said.
The projected last year that the U.S. of up to 86,000 physicians by 2036 鈥� if lawmakers don鈥檛 invest more money in training doctors.
These shortages could push more people to seek care in ERs when they can鈥檛 see a local doctor, said , director of workforce studies at the AAMC.
鈥淲e鈥檙e already at a point where tens of millions of Americans every year can鈥檛 get medical care when they need it,鈥� said Dill (no relation to Janette Dill). 鈥淚f the shortage is sustained or gets even worse, then that problem gets worse too, and it disproportionately negatively impacts the most vulnerable amongst us.鈥�
Iowa lawmakers made addressing the shortage in the current legislative session. They introduced bills aimed at increasing medical student loan forgiveness and requesting federal help to add residency training slots for medical students in the state.
Last year, Gov. Kim Reynolds that drops the residency requirement for some doctors who trained abroad to get a medical license. Lawmakers in at least eight other states have approved similar changes.
Patterson, of the Washington County hospital, appreciates that Iowa lawmakers are trying to increase the pipeline of doctors into Iowa but said it doesn鈥檛 address immediate shortages.
鈥淵ou have a high school student who鈥檚 graduating right now; they鈥檙e probably nine to 11 years away from entering the workforce as a practicing physician. So it鈥檚 a long-term kind of problem,鈥� he said.
For nurses, workforce experts say, the projected national outlook isn鈥檛 as dire as in recent years.
鈥淣ursing education is back up. Nursing employment rates are back up. I think, for that workforce, we鈥檝e largely nationally recovered from all the dislocations that occurred,鈥� said Spetz, of the Institute for Health Policy Studies.
But getting nurses to move to the places that need them, like rural communities, will be difficult, she said.
Some rural hospitals in Iowa say an even bigger challenge right now is finding nurses to hire.
Some of that can be traced to the pandemic, said Sara Bruns, nurse manager at Keokuk County Hospital and Clinics. She recalled that some covid patients in critical condition died when they couldn鈥檛 be transferred to larger hospitals with more advanced intensive care unit equipment, because those hospitals didn鈥檛 have the staff to take on more patients.
鈥淲e had to make the horrible decision of 鈥榊ou鈥檙e probably not going to make it,鈥欌�� Bruns recalled, saying many patients were then listed as DNR, for 鈥渄o not resuscitate.鈥�
鈥淭hat took a big toll on a lot of nurses,鈥� she said.
Another problem is persuading the area鈥檚 young nurses to stay, when they would rather live and work in more urban areas, Bruns said.
Her hospital still relies on contracts with travel nurses to fill some night shifts. That鈥檚 something the hospital never had to do before the pandemic, Bruns said. Travel nurses are , adding stress to a small hospital鈥檚 budget.
鈥淚 think some people just completely got out of nursing,鈥� Bruns said. The pandemic took a special toll 鈥渂ecause of the hours that they had to work, the conditions that they had to work.鈥�
Policymakers and health care organizations can鈥檛 focus only on recruiting workers, according to Janette Dill at the University of Minnesota. 鈥淵ou also have to retain workers,鈥� she said. 鈥淵ou can鈥檛 just recruit new people and then have them be miserable.鈥�
Dill said workers report feeling that patients have been more disrespectful and challenging since the pandemic, and sometimes workers at work. 鈥淏y 鈥榰nsafe鈥� I mean physically unsafe. I think that is a very stressful part of the job,鈥� she said.
Research has shown health workers of burnout and poor mental health since the pandemic 鈥� though the risks decreased if workers felt supported by their managers.
Gail Grimes, an intensive care nurse in Des Moines, felt more supported by her employer during the worst parts of the pandemic than she does now, she said. Some hospitals offered pay bumps and more to keep nurses on staff.
鈥淲e were getting better bonus pay,鈥� Grimes recalled. 鈥淲e were getting these specialized contracts we could fulfill that were often more worth our time to be able to come in, to miss our families and be there.鈥�
Grimes said she鈥檚 seen nurses leave Iowa for neighboring states with better average pay. This creates shortages that she believes affect the care she gives her own patients.
鈥淎 nurse taking care of five patients will always be able to provide better care than a nurse taking care of 10 patients,鈥� she said.
She thinks many hospitals have simply accepted staff burnout as a fact, rather than try to prevent it.
鈥淚t really is significantly impactful to your mental health when you come home every day and you feel guilty about the things you have not been able to provide to people,鈥� she said.
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